Evaluation of anaesthetic services in selected Gauteng hospital

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Medicine in the branch of Anaesthesiology. Johannesburg, 2017Anaesthesia is an important aspect of clinical medicine. The quality, safety, education and training in anaesthesia have an impact on the outcome of patient care. The overall aim of the study was to evaluate anaesthetic services in selected Gauteng hospitals. This study was done in two parts. Part 1 evaluated the level of training of doctors administering anaesthesia, the range of procedures performed and the perception of training adequacy for the anaesthesia they administered. Part 2 of the study reviewed a total number of 585 procedures performed over a two week period in August 2015. Procedures performed and type of anaesthesia employed as well as the length of stay post the procedure were analysed. The majority of doctors, 72.4%, administering anaesthesia had neither an anaesthetic postgraduate qualification nor any recognised resuscitation certificate such as ACLS or ATLS. Although 58.6 % of doctors felt that the training they had received was adequate for the type of surgical cases they were expected to anaesthetise, some junior doctors highlighted inadequate supervision. The majority of procedures, 47.4%, were obstetrics caesarean sections, of which 96.0% were performed under spinal anaesthesia. There was no statistically significant difference in length of stay between obstetric patients who had either a general or spinal anaesthesia. Anaesthetic records were retrieved in 97.8% of the cases. Post-operative observations were recorded prior to discharge from the recovery room in 97.2% of patients. There were no anaesthetic related complications reported or noted during the two week study period. The majority of doctors were not trained in anaesthesia, however no complications occurred during the study period. Furthermore, the majority of procedures done were obstetrics using spinal anaesthesia. This is in contrast to the Green-Thompson (1) study that found that the majority of obstetric cases were done under general anaesthesia. There was also a substantial improvement in record keeping.MT201

Using The RE-AIM Framework to Evaluate the Programmatic Management of Latent Tuberculosis Infection in Maine

Background: Treating Latent tuberculosis infection (LTBI) which is asymptomatic and a reservoir for TB disease is essential to end tuberculosis. This project focused on identifying gaps in programmatic management of LTBI in the state of Maine and the creation of minimum data metrics to serve as a framework for potential quality improvement initiatives. Methods: Participants included Maine Medical Center/TB Clinic, referring primary care sites, their staff, and the Public Health Nursing Central Referral Office. The number of referrals to TB Clinic, number of attendances, number of individuals diagnosed and prescribed with LTBI treatment, number of treatment initiations, number of treatment refusals, number of clients lost to follow-up were retrospectively collected from existing published reports and electronic medical records for 2019. An online survey monkey was used to collect data from partner organizations. Results: A total of 169 LTBI cases were identified where individual were diagnosed and prescribed treatment by Public Health. The level of adherence to LTBI treatment was 38% which is low, but consistent with average rates in the United States. In the online survey staff had adequate knowledge about LTBI (100%) on integration of preventive therapy and TB disease treatment and 80% agreed that follow up after referral is the primary care provider’s responsibility. Identified barriers included lack of a structure, resources, and follow-up systems to ensure optimal outcomes along with lack of recognition of the importance of screening and management of LTBI in the medical community. Most respondents (80%) were supportive of LTBI awareness raising interventions, particularly migrant communities and the screening of new immigrants without delay. Reach scored low for awareness and screening with a lack of data on outreach to at-high risk groups and effectiveness due to lack of a strategic plan and budget. Conclusion: Adequate planning, implementation and evaluation that apply systems thinking, sector wide approach, data and implementation sciences are needed to narrow identified performance gaps. Additional resources are needed in terms of policies, guidelines and human infrastructure for the state’s monitoring and treatment of LTBI. Keywords: latent tuberculosis infection, treatment, cascade of care, gaps, complianc

Examination of maternal gingival crevicular fluid for the presence of selected periodontopathogens implicated in the pre-term delivery of low birthweight infants

Background: Reports show that more than 20 million infants world-wide are born prematurely with 95% of all pre-term births occurring in developing countries. Oral colonization of Gram-negative anaerobes has been implicated as a risk factor for preterm delivery of low birth weight infants. Results: Association of bacterial species with the risk of periodontal disease and thus the risk of preterm delivery was only observed when they occurred in pairs or groups of three or more. Aa appeared to be a necessary co-factor for significant associations of bacterial groups with the variables recorded. Materials and Methods: This study comprised 200 women admitted to the department of obstetrics and gynecology of the teaching hospital of Butare in Rwanda. Gingival crevicular fluid was collected from each quadrant of the mother’s mouth (using paper points) within 24 hours of delivery. A dichotomous score of presence or absence of gingival inflammation was recorded for each patient along with demographic data such as age, marital status etc. Samples were examined by PC R for the presence of Aggregatibacter actinomycetemcomitans and selected members of the red and orange complexes described by Socransky et al. (1998), and their presence associated with age, gingival inflammation and pregnancy outcomes.National Research Foundation of South AfricaWeb of Scienc

Prevalence of Entamoeba histolytica in stool specimens at Muhondo Health Center, Rwanda

Entamoeba histolytica is a protozoan parasite causing amebiasis. It occurs usually in the large intestine and causes internal inflammation as its name means (histo = tissue, lytic = destroying). Between 40 and 50 million people are infected worldwide, mostly in tropical countries, in areas of poor sanitation. The infection occurs by ingestion of mature cyst in fecally contaminated food, water or hands. The disease shows different symptoms including vomiting, abdominal pain, nausea, watery and bloody diarrhea. While the infection becomes extra intestinal, it may cause abscess in other organs such as liver, kidney, brain and lungs.The present study was carried out to determine the prevalence of E. histolytica in stool specimens at Muhondo Health Center. A total of 103 fecal specimens were collected over a period of three months. Out of 103 specimens, only 26 (25.2%) were positive for E. histolytica. Out of the 26 specimens positive for E. histolytica, 17 (16.5%) and 9 (8.7%) were from males and females respectively. Furthermore, of the 26 Specimens positive for E. histolytica, 15 (14.6%) and 11 (10.7%) were from people ≤ 15 and >15 years of age respectively. Entamoeba histolytica was more prevalent 26 (25.2%) than other parasites including Giardia with 15 (14.6%), Ascaris sp with 5 (4.9%), Trichomonas intestinalis with 16 (15.5%) and Entamoeba coli with 1 (1%). In order to reduce Entamoeba histolytica contamination and infections, the following recommendations were pointed out: (i) improving personal hygiene (washing hand before eating and after using latrines) ; (ii) avoiding fecal contamination of food, water, and utensils ; and (iii) boiling drinking water before consumption.Keywords: Parasites, Prevalence, Entamoeba histolytica, amebiasis, Stool specimens, Muhondo Health Cente

Risk factors of preterm delivery of low birth weight (plbw) in an African population

More than 20 million infants in the world (15.5% of all births) are born with low birth weight. Ninety-five percent of them are in developing countries. The objective of this study was to examine different factors which may contribute to preterm delivery of low birth weight (PLBW) in a recent sample of Rwandan birth. The study sample included 200 randomly selected women admitted to the department of obstetrics-gynecology of the teaching hospital of Butare in Rwanda. Mothers were asked to complete a questionnaire and obstetrics records were used in order to identify factors which might pose a health risk to them and their infants. Maternal weight, height, history of previous preterm and healthy conditions of the children in the family showed a significant relationship with PLBW. Maternal level of education, number of pregnancies of the mother, urinary tract infection, sexually transmitted disease, antibiotic administration, diabetes, history of heart disease, alcohol consumption and smoking showed a relationship with PLBW but the relationship was not significant. More studies are required for a better understanding of the mechanism leading to preterm delivery of low birth infants.National Research Foundation of South Afric

Regulation environment in Africa

Meeting : UbuntuNet Conference, November 18-19, 2010PowerPoint presentatio

A molecular investigation of the prevalence of suspected periodontopathogens and their association with preterm birth

Philosophiae Doctor - PhDMore than 20 million infants in the world (15.5 % of all births) are born with low birth weight. Ninety-five % of them are in developing countries. Oral colonization of Gramnegative anaerobes has been implicated as a risk factor for preterm delivery of low birth weight (PLBW) infants. The objective of this study was to investigate the association between periodontal pathogens and pre-term delivery of low birth weight (PLBW) infants. The study sample included 200 randomly selected women admitted to the department of obstetrics-gynecology of the teaching hospital of Butare in Rwanda. Mothers were asked to complete a questionnaire in order to identify factors which might pose a health risk to them and their infants. Gingival crevicular fluid (GCF) was collected from each quadrant of the mother’s month (using paper points) within 24 hours of delivery. Ten ml of foetal cord serum samples were collected at delivery and 10 ml of maternal serum samples were collected within 48 of delivery. GCF was examined by PCR for the presence of 5 periodontopathogens and ELISA was used for the evaluation of cytokines (IL-6 and IL-10) and immunoglobulins (IgM, IgG) in foetal cord and maternal blood against the periodontopathogens. P. intermedia showed significant associations either on its own or in combinations with most indicators of periodontal disease used in this study, while Aa and members of the red complex were significantly associated with gum bleeding and reduced frequency of tooth brushing. A strong association between PLBW and maternal and foetal cord serum sample levels of IL-10 was observed. Also, a good association was observed between PLBW and FCB sample levels of IL-6. Significant associations were observed between PLBW and maternal IgG against the different peridontopathogens. The findings of this study may suggest that the levels of maternal IgG and foetal IgM against the different periodontopathogens are associated with dissemination of maternal periodontopathogens to the foetus thereby illiciting an inflammatory response which contributes to PLBW.South Afric

"A molecular investigation of the prevalence of suspected periodontopathogens and their association with preterm birth"

Philosophiae Doctor - PhDMore than 20 million infants in the world (15.5 % of all births) are born with low birth weight. Ninety-five % of them are in developing countries. Oral colonization of Gramnegative anaerobes has been implicated as a risk factor for preterm delivery of low birth weight (PLBW) infants. The objective of this study was to investigate the association between periodontal pathogens and pre-term delivery of low birth weight (PLBW) infants. The study sample included 200 randomly selected women admitted to the department of obstetrics-gynecology of the teaching hospital of Butare in Rwanda. Mothers were asked to complete a questionnaire in order to identify factors which might pose a health risk to them and their infants. Gingival crevicular fluid (GCF) was collected from each quadrant of the mother’s month (using paper points) within 24 hours of delivery. Ten ml of foetal cord serum samples were collected at delivery and 10 ml of maternal serum samples were collected within 48 of delivery. GCF was examined by PCR for the presence of 5 periodontopathogens and ELISA was used for the evaluation of cytokines (IL-6 and IL-10) and immunoglobulins (IgM, IgG) in foetal cord and maternal blood against the periodontopathogens. P. intermedia showed significant associations either on its own or in combinations with most indicators of periodontal disease used in this study, while Aa and members of the red complex were significantly associated with gum bleeding and reduced frequency of tooth brushing. A strong association between PLBW and maternal and foetal cord serum sample levels of IL-10 was observed. Also, a good association was observed between PLBW and FCB sample levels of IL-6. Significant associations were observed between PLBW and maternal IgG against the different peridontopathogens. The findings of this study may suggest that the levels of maternal IgG and foetal IgM against the different periodontopathogens are associated with dissemination of maternal periodontopathogens to the foetus thereby illiciting an inflammatory response which contributes to PLBW

Hospital acquired infections in pediatrics unit at Butare University Teaching Hospital (CHUB)

Background: Hospital acquired infection (HAI) also called nosocomial infection is an infection acquired in hospital or other healthcare facilities. HAIs are a major public health problem all over the world, but particularly in developing nations and they are among the major causes of death and increased morbidity among hospitalized patients. It was found that HAI in sub-Saharan Africa is the major cause of illness and death in children.Aim: The aim of this study was to provide knowledge on the prevalence of hospital acquired infection in pediatric unit of the University Teaching Hospital of Butare (Rwanda).Methods: Hospital acquired infections surveillance method and definition of infections described by CDC/NHSN were used.Results and conclusion: This study showed that the prevalence of HAI was very high (12.1 %) and the main bacteria causing NIs in pediatric unit were Kleblesiela pneumonia, followed by E. coli and Staphylococcus aureus. Low Respiratory HAIs were the most prevalent.Keywords: Prevalence, Hospital Acquired infection, Pediatric

The Use of Benzoyl-Dl-Arginine-Naphthylamide (Bana) Test as A Screening Test for Mother at Risk for Delivery of Pre-Term and Low Birth Weight in A Rwandan Population

Oral infections can act as the site of origin for dissemination of periodonto-bacteria and their toxins as well as induce inflammatory mechanisms to distant body sites, thus linking periodontal diseases to pre-term delivery of low birth weight (PLBW) infants. Periodontal disease is an infection of the tissues surrounding and supporting the teeth. Researchers showed that between 18 and 50 % of all pre-term deliveries are associated with periodontal disease. Porphyromonasgingivalis, Treponema denticola and Tannerella forsythia are among the subgingival microflora most frequently associated with periodontal disease. The presence of these bacteria can be identified by their ability to hydrolyse BANA. BANA is a rapid and effective diagnostic aid shown to correlate well with the clinical indices used to diagnose periodontal disease. The objective of this study was to investigate the association between the presence of member of the red complex (BANA positive species) in subgingival plaque and pre-term delivery of low birth weight in a Rwandan population. Three clinical indices (PI,GI and PD) were measured for each patient. Plaque sample were collected by inserting a sterile probe into the base of the pocket and this served for the measurement of the BANA enzyme test. The age of the population study was between 18 and 47 years with a mean of 30.8(+or-5.34). Among the 450 women examined, 57.1 % had a PI score of 2, 56.0 % had GI score of 2 and 89.6 % had a PD between 4-6 mm. At a level of 5%, a significant association of p-value=0.000 was found between PI vs BANA, GI vs BANA and PD vs BANA. No significant association (p-value=0.073) was found between BANA and mothers who delivered preterm of low birth weight (PLBW). In conclusion, findings of this study showed that BANA cannot be used for now as screening test for mother at risk for preterm delivery, while waiting for a multicenter study which will help to verify the cause of these discrepancies of results. In the other hand we can recommend BANA to be used as a routine test for the detection of periodontal disease due it strong relationship with clinical indices used to diagnose periodontal disease